1730482035 NPI number — MS. NNEKA NWAMAKA MOTANYA PA-C

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730482035 NPI number — MS. NNEKA NWAMAKA MOTANYA PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MOTANYA
Provider First Name:
NNEKA
Provider Middle Name:
NWAMAKA
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1730482035
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/12/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 6752
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANNAPOLIS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21401-0752
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
888-808-6483
Provider Business Mailing Address Fax Number:
888-721-8040

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5255 LOUGHBORO RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-2633
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
888-808-6483
Provider Business Practice Location Address Fax Number:
888-721-8040
Provider Enumeration Date:
12/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363AM0700X , with the licence number:  C05672 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363AM0700X , with the licence number: PA030719 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: PA030719 . This is a "PHYSICIAN ASSISTANT LICENSE NUMBER" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".
  • Identifier: C05672 . This is a "PHYSICIAN ASSISTANT LICENSE" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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